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Date run 12/2012016 3:39:19P SAN JOAQUIN COUNTYENVIRONiMENTAL HEALTH DEPARTMENT <br /> Run by Report#5021 <br /> Facility Information as of 12/20/2016 Pagel <br /> Record Selection entena: Facility ID FA0009941 <br /> Make changeslcorrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner : 1 OWNERSHIP CHANGE(date) <br /> SSN/Fed Tax ID <br /> Owner ID OW0007941 Case Number: H05938 New Owner ID <br /> Owner Name RON & DEANNA GOEHRING <br /> Owner DBA GOEHRING PUMP & IRRIGATION <br /> Owner Address 17754 N HWY 88 <br /> LOCKEFORD, CA 95237 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-727-5548 <br /> Mailing Address PO BOX 113 <br /> LOCKEFORD, CA 95237 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID/CERS ID FA0009941 10183047 <br /> Facility Name GOEHRING PUMP & IRRIGATION <br /> Location 17754 N HWY 88 <br /> LOCKEFORD, CA 95237 <br /> Phone 209-727-5548 x <br /> Mailing Address PO BOX 113 <br /> LOCKEFORD, CA 95237 <br /> Care of Ron Goehring <br /> Location Code 99 - UNINCORPORATED A Alt Phone <br /> BOS District 004 - WINN. CHARLES Fax <br /> APN 05125010 Entail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name <br /> Title <br /> Day Phone <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0016941 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner 1 Facility / Account <br /> Account Name GOEHRING PUMP & IRRIGATION (circle One) <br /> Account Balance as of 12/20/2016: $0.00 <br /> (Circle One) <br /> Transfer to Activellnaetve <br /> ProgramlEdement and Oescnption Record ID Employee iD and Name Status New Owner? Delete <br /> 1921 -HMBP-Regular-Primary Location PRO519976 EE0008709-JAMIE LIMA Active Y N A I D <br /> 2220-SM HW GEN<5 TONSIYR PR0514103 EE0001422-ARIS VELOSO Active Y N A D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATION PR0512229 EE0000000-HAZ MAT SJC OES InactiVE Y N A D <br /> 2333-EXCLUDED FARM TANK PRO501799 EED000005-FATINAH ZAREEF InactiVE Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARGE F1 PR0509941 EE0000000-HAZ MAT SJC OES Inactiv€ Y N A I D <br /> 2830-AST FAC -SPCC EXEMPT PRO535643 EE0001422-ARIS VELOSO InactivE Y N A I D <br /> ERSC-ELECTRONIC REPORTING STATE SURCHARGI PR0531999 InactivE Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT. I,the undersigned owner,operator or agent of same,acknowledge that all site,and/or project specific,PHS/FHD hourly charges associated with this facility <br /> or activity will be billed to the party identified as the OWNER on this form. I also certify that all operations will be performed in accordance with all applicable Ordinance Codes and/or Standards and State and/or <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: Date ! 1 <br /> Program Records to be TRANSFERED: '$25.00= Amount Paid Date 1 I <br /> Water System to be TRANSFERED: Amount Paid Date J I <br /> Payment Tye Check Number Receivedby,)_ <br /> EHD Staff: Date lL 1 ^ I Account out: IJOV Date <br /> j�COMMENTS; y�/� f/} /� n p �f Q,�. <br /> 1 J� � + l ! �V `V [.�L}�aV Ui Ca �� Invoice#: <br />